[Mandibular osteitis on a periapical granuloma mimicking an osteosarcoma: a case report]. / Ostéite mandibulaire sur un granulome péri-apical faisant évoquer un ostéosarcome. A propos d'un cas Clinique.

Introduction: Osteitis is an inflammatory disease of bone tissue. Its clinical presentation varies according to the site, presence or absence of pus, duration and etiology. It represents one of the endo-periodontal diseases complication. We report the case of a mandibular osteitis having led to confusion with an ostesarcoma. Observation: A 13-year-old boy was referred to our department for a right low swelling with suspicion of mandible osteosarcoma. The lesion's evolution was 6 weeks. With the local aggressiveness and the speed evolution, the first diagnosis proposed was a mandibular osteosarcoma. Based on the clinical and radiological data established, the diagnosis of mandibular osteitis on a periapical granuloma was made and the treatment consisted on the causal tooth extraction with curettage of the periapical lesion associated to the prescription of macrolide (ERY®). The clinical follow-up was 6 weeks, a recovery with cessation of clinical signs were noticed. Discussion: The differential diagnosis facing the clinical context is an osteitis on a periapical inflammatory cyst and especially mandibular osteosarcoma. For the therapy, it's a 3 components treatment (etiology, medical and surgical) to obtain a recovery.

Investigation of cultivable bacteria isolated from longstanding retreatment-resistant lesions of teeth with apical periodontitis.

INTRODUCTION: The objective of this research was to investigate the presence of viable bacteria in tissue samples from persistent apical lesions and to correlate the microbiological findings with the histopathological diagnosis of the lesion. METHODS: Twenty persistent apical lesions associated with well-performed endodontic retreatment were collected. Tissue samples were processed through culture techniques including serial dilution, plating, aerobic and anaerobic incubation, and biochemical tests for microbial identification followed by histopathological diagnosis. RESULTS: Cysts were more frequently diagnosed (13/20). Strict anaerobic species predominated in both cysts (80.4% of the species detected) and granulomas (65% of the species detected). Viable gram-positive bacteria were frequently recovered from apical lesions (cysts = 70.6%, granulomas = 84.4%). Gemella morbillorum and Propionibacterium acnes were the most frequently recovered species from cysts and granulomas, respectively. At least 1 gram-positive bacterial species was present in almost every sample (cysts = 12/13, granulomas = 7/7). No significant correlation was found between histologic findings and bacterial species. CONCLUSIONS: In conclusion, although cysts were more frequent than granulomas in cases of failure of endodontic retreatment, bacteria were isolated from both types of lesions, with a predominance of gram-positive species, suggesting that these species can survive outside the root canal and might be related to the persistence of the pathological process even after accurate endodontic retreatment.

Nonsurgical root canal therapy of large cyst-like inflammatory periapical lesions and inflammatory apical cysts.

It is a general belief that large cyst-like periapical lesions and apical true cysts caused by root canal infection are less likely to heal after nonsurgical root canal therapy. Nevertheless, there is no direct evidence to support this assumption. A large cyst-like periapical lesion or an apical true cyst is formed within an area of apical periodontitis and cannot form by itself. Therefore, both large cyst-like periapical lesions and apical true cysts are of inflammatory and not of neoplastic origin. Apical periodontitis lesions, regardless of whether they are granulomas, abscesses, or cysts, fail to heal after nonsurgical root canal therapy for the same reason, intraradicular and/or extraradicular infection. If the microbial etiology of large cyst-like periapical lesions and inflammatory apical true cysts in the root canal is removed by nonsurgical root canal therapy, the lesions might regress by the mechanism of apoptosis in a manner similar to the resolution of inflammatory apical pocket cysts. To achieve satisfactory periapical wound healing, surgical removal of an apical true cyst must include elimination of root canal infection.

[Longitudinal study of the efficacy of conservative endodontic treatment for chronic periapical lesions]. / Studiu longitudinal privind eficienta tratamentelor endodontice conservatoare pe un lot de dinti cu leziuni periapicale cronice.

UNLABELLED: Our study aimed to assess the possibilities of healing in periapical lesions following endodontic therapy, using a standardised technique. MATERIAL AND METHODS: Study group included 34 patients with 15-45 age. 40 teeth with periapical granuloma and periapical difuse osteitis were endodontically treated. All teeth presented radicular obturations with adequate length and density consisting of gutaperca points and antiseptic sealer (Endoflas, Sanlor). Optimum coronal sealing was provided through prosthetic restorations or composite resins associated with glassionomer cements. All treated teeth were radiographically monitorised on a 24 months time interval. Periapical Index (PAI) were used for assessment of periapical healing processes. Recorded data were used for statistical analysis in SPSS 16 trial. RESULTS: The assessment of periapical status after 24 months showed a complete periapical healing for 42.5% teeth (PAI 1-2), partial periapical healing for 52.5% teeth and 5% endodontic failures. Median values for PAI indices decreased from an initial 4.75 value to 4.30 after 3 months, 3.33 after 12 months and 2.60 after 24 months. Wilcoxon tests confirm significant statistical differences between PAI indices at different time intervals. CONCLUSIONS: Adequate radicular obturation associated with optimum coronal sealing provide a favourable environment for periapical healing processes, providing success in endodontic therapy of chronic apical periodontitis. Time interval represents a major factor that influences periapical remineralisation degree.

Exarticulation and reimplantation utilizing guided tissue regeneration: a case report.

The extraction and reimplantation of teeth is a technique that has been practiced for many years, resulting in successful retention of teeth for up to 30 years. Although evidence confirming the advantages of this technique is limited, clinical observations and histologic examinations have revealed some important factors that are prerequisites for success: limitation of the time the tooth is exposed to the extraoral environment and preservation of vital periodontal tissue attachments on root surfaces. The latter goal can be achieved by gentle, atraumatic removal of the tooth from its socket, and hence the term exarticulation and reimplantation is more representative of the technique. In the present case report, a maxillary lateral incisor with a developmental defect was treated by exarticulation and reimplantation and application of calcium sulfate. Exarticulation and reimplantation seems to be a useful clinical procedure, but controlled studies are required to confirm its efficacy.

Identification of GM3 as a marker of therapy-resistant periradicular lesions.

The purpose of this study was to analyze the profile of glycosphingolipids (GSLs) in periradicular lesions refractory to endodontic treatment. Sixteen periapical lesions were removed surgically from patients (experimental group) and compared with 10 samples of periodontal ligament removed from extracted intact third molars (control group). After the GSLs extraction and purification procedures were performed the neutral and acidic GSL fractions were analyzed by high-performance thin-layer chromatography and quantified by densitometry. Data reported herein show that: (i) tissues in the experimental group presented about twice as much GSLs as the control group; (ii) lesion tissues express lactoneotetraosylceramide, and lactofucopentaosyl (IV) ceramide, whereas these neutral GSLs are absent in normal tissues; and (iii) normal tissues express GT1b, whereas lesions cells do not express this ganglioside. In contrast lesion tissues express GM3, which is conspicuously absent in normal tissues.

Mineral trioxide aggregate (MTA) as a root end filling material in apical surgery--a case report.

Many root end filling materials for apical surgeries have been identified either for scientific evaluation or clinical usage but none meets the requirements of an ideal root end filling material. Recently a new cement, Mineral Trioxide Aggregate (MTA) was researched as a potential root end filling material and showed promising results. This paper reports the significant findings of research done on MTA as a root end filling material and presents a clinical case where apical surgery was performed using MTA as retrograde filling.

A conservative biopsy technique for periapical lesions.

This paper presented a conservative technique for biopsy of periapical lesions. The case report demonstrated the insertion of a flexible microsurgical biopsy forceps through a labial sinus tract into a lesion for removal of specimens for histopathological evaluation. This limited tissue removal seemed to induce a change from a cyst to a granuloma, as well as stimulate a degree of repair.

Nonsurgical root canal therapy treatment with apparent indications for root-end surgery.

The recent introduction of the surgical microscope to the practice of endodontics, especially for surgery, has allowed clearer visualization of the periapex during root-end resection and filling. However, despite this and other technologic advances, it has not been demonstrated that in the absence of thorough canal debridement the success rate of periapical surgery has improved over the 50% to 60% demonstrated in most long-term prognosis studies. Therefore it remains important to fully instrument and obturate the root canal system with conventional therapy before surgery is considered; this considerably improves the long-term prognosis. Each of the case reports in this article involves a situation in which conventional treatment was performed when a surgical approach might have been considered as the treatment of choice. Surgery should not be considered to be the primary treatment when root canal treatment or retreatment may be readily achieved. Indeed, the operating microscope and other technical aids will probably allow more cases to be treated and retreated conventionally that might otherwise have required surgical intervention.

[The use of a Hydroxyapol-containing zinc-eugenol paste for the filling of dental canals in treating periodontitis]. / Primenenie gidroksiapolsoderzhashchei tsink-évgenolovoi pasty dlia plombirovaniia kanalov zubov pri lechenii periodontita.

Comparative assessment of the efficacy of two-staged treatment of patients with chronic apical periodontitis by hydroxyapol-containing paste and zink-eugenol paste demonstrated the desirability of adding hydroxyapol powder in the radical paste for the treatment of apical periodontitis.

[The results of treating exacerbated chronic periodontitis using sorbents]. / Rezul'taty lecheniia obostrivshikhsia khronicheskikh periodontitov s primeneniem sorbentov.

The authors claim that sorbents effectively discontinue an acute inflammatory process, are conducive to the creation of active drainage in the periodontium and to a reduction of the incidence of complications. They recommend therapy with sorbents for the treatment of exacerbations of chronic periodontitis.

[Current perspectives on endodontic treatment of teeth with chronic periapical lesions]. / Perspectivas actuales del tratamiento endóncico en dientes con lesiones periapicales crónicas.

The author study in this article histopathological aspects of periapical lesions, intra-granulomatous epithelial proliferation phenomenon as pathogenic mechanism of microscopic cystic cavities formation, diagnostic problems of them all, as well as the most actual therapeutic perspectives.

[Orthograde treatment of large lesions of endodontic origin: clinico-statistical study]. / Il trattamento ortogrado delle grandi lesioni di origine endodontica: contributo clinico statistico.

The author presents a personal contribution in favour of the orthograde treatment for periapical diseases which have endodontic origins. The obtained results in 136 treated cases justify the conservative approach also in those cases in which the apical pathology is characterized by "cystic" dimension and radiological aspect.

[The combined diagnosis of apical periodontitis by using color x-ray teledensitometry and photoplethysmography]. / Kompleksnaia diagnostika verkhushechnykh periodontitov s pomoshch'iu tsvetovoi rentgenoteledensitometrii i fotopletizmografii.

Comparative evaluation of diagnostic resolution capacity of roentgenological and photoplethysmographic (PPG) investigation was performed in 201 patients with periodontitis. Acute periodontic inflammation (103 patients) was detected in 98% of the cases with PPG and in 94.1% of the cases it allowed to clarify the form of the disease. The respective values for roentgenology were 33.9% and 58.3%. In 98 patients with remitting periodontitis both techniques showed virtually equal diagnostic powers 90.8% for X-rays, and 84.5% for PPG. Color X-ray densitometry sharply increased informative value of conventional X-ray investigation. Roentgenological and functional diagnostic techniques should be combined in diagnosis of periodontal pathology.